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Introduction Patients with chronic kidney disease (CKD) who require maintenance hemodialysis (HD) treatment for survival have a high mortality of approximately 20% in the U.S. A high values of body mass index are associated with improved survival. obesity paradox obesity is risk factor of cardiovascular disease in patients with CKD or cardiac disease 7

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Dry weight change during the first 6 months & predictor of mortality 12 Figure 2. Change in dry weight during the first 6 months of the cohort as a predictor of mortality in 57,247 patients receiving hemodialysis(HD) who survived through the first 2 calendar quarters

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Change in serum creatinine concentration & mortality 14 Figure 4. Change in serum creatinine concentration (a surrogate of change in muscle mass) during the first 6 months of the cohort as a predictor of mortality in 58,201 patients receiving hemodialysis (HD) who survived through the first 2 calendar quarters

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Introduction Surrogate measures of abdominal obesity and segmental fat distribution (waist circumference and waist/hip ratio [WHR]) are stronger predictors of all-cause and CV death than body mass index (BMI) in the general population, but the issue has never been investigated in patients with ESRD. 28

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Purpose The aim of this study was to investigate the predictive value for all-cause and cardiovascular (CV) death of anthropometric measurements of abdominal obesity in patients with end-stage renal disease (ESRD).

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34 Conclusion Abdominal obesity underlies a high risk of all- cause and CV mortality in patients with ESRD. Redefinition of nutritional status by combining the metrics of abdominal obesity and BMI may refine prognosis in the ESRD population